Wijewickrama Piyumi Sachindra Alwis, Rajaratnam Henry N
Endocrinology Unit, National Hospital of Sri Lanka, Colombo 10, 00700, Sri Lanka.
Nawaloka Hospitals PLC, 23, Deshamanya H. K Dharmadasa Mawatha, Colombo 2, 00200, Sri Lanka.
Case Rep Endocrinol. 2020 Sep 17;2020:1735351. doi: 10.1155/2020/1735351. eCollection 2020.
Hypoparathyroidism, which is a common complication following total thyroidectomy can be transient in majority and permanent in 1.5% of the patients and usually occurs secondary to an inadvertent removal of parathyroid glands, mechanical or thermal injury or disruption of the vasculature. In some patients, it is observed that symptoms of hypocalcemia can occur for the first time several years after the surgery, which is known as "delayed hypoparathyroidism." We report three cases of delayed hypoparathyroidism from Sri Lanka, presenting several years after total thyroidectomy. Case 1- a 60-year-old Sri Lankan woman who presented with symptomatic hypocalcemia for the first time, 30 years after total thyroidectomy for follicular thyroid carcinoma. Case 2- a 53-year-old Sri Lankan woman presenting with neuropsychiatric manifestations of hypocalcemia for the first time, 12 years after total thyroidectomy for papillary thyroid carcinoma. Case 3- a 49-year-old Sri Lankan woman developing symptoms of hypocalcemia for the first time, 11 years after completion of thyroidectomy for papillary thyroid carcinoma. All these patients were detected to have low parathyroid hormone levels, without an alternative etiology for hypoparathyroidism, hence leading to a diagnosis of delayed post-thyroidectomy hypoparathyroidism.
Delayed hypoparathyroidism is a rare phenomenon, which is secondary to progressive atrophy of parathyroid glands and slowly progressive hypovascularization of parathyroids due to scar tissue retraction following thyroidectomy. The nonspecific nature of hypocalcemic symptoms and lack of continuous follow-up for a long time after thyroidectomy could contribute to a further delay in diagnosis. However, it is an important diagnosis to consider in any patient with a history of neck surgery presenting with hypocalcemia, irrespective of the time duration of surgery, as timely diagnosis and treatment can prevent long-term complications of hypocalcemia and improve the quality of life.
甲状旁腺功能减退是全甲状腺切除术后常见的并发症，多数为暂时性，1.5%的患者为永久性，通常继发于甲状旁腺意外切除、机械或热损伤或血管系统破坏。在一些患者中，术后数年首次出现低钙血症症状，这被称为“迟发性甲状旁腺功能减退”。我们报告3例来自斯里兰卡的迟发性甲状旁腺功能减退病例，均在全甲状腺切除术后数年出现症状。病例1：一名60岁的斯里兰卡女性，因滤泡性甲状腺癌行全甲状腺切除术后30年，首次出现有症状的低钙血症。病例2：一名53岁的斯里兰卡女性，因乳头状甲状腺癌行全甲状腺切除术后12年，首次出现低钙血症的神经精神症状。病例3：一名49岁的斯里兰卡女性，在乳头状甲状腺癌甲状腺切除术后11年首次出现低钙血症症状。所有这些患者均检测到甲状旁腺激素水平低，且无甲状旁腺功能减退的其他病因，因此诊断为甲状腺切除术后迟发性甲状旁腺功能减退。
迟发性甲状旁腺功能减退是一种罕见现象，继发于甲状旁腺的渐进性萎缩以及甲状腺切除术后瘢痕组织收缩导致的甲状旁腺缓慢渐进性血管减少。低钙血症症状的非特异性以及甲状腺切除术后缺乏长期持续随访可能导致诊断进一步延迟。然而，对于任何有颈部手术史且出现低钙血症的患者，无论手术时间长短，这都是一个重要的诊断考虑因素，因为及时诊断和治疗可以预防低钙血症的长期并发症并提高生活质量。
